Drug Label Information

Methazel is an orally administered prescription dietary supplement specifically formulated for the dietary management of patients with unique nutritional needs requiring increased folate levels as well as other supplementation.

* This product is a prescription vitamin that – due to increased folate levels (AUG 2 1973 FR 20750), requires an Rx on the label because of increased risk associated with masking of B12 deficiency. As such, this product requires licensed medical supervision, an Rx status, and a National Drug Code (NDC) as required by pedigree reporting requirements.

FOLATE REGULATIONThe term "folate" are B vitamins that include folic acid and any forms of active pteroylglutamates regardless of the reduction state of the molecule. Folates, or vitamin B9, are primarily hydrolyzed in the intestinal jejunum and the liver to the active circulating form of folate.

Folic acid, including reduced forms1 such as folinic acid, may obscure pernicious anemia above 0 .1 mg doses, and must be administered under the supervision o f a licensed medical practitioner.

Methazel is indicated for the distinct nutritional requirements of patients in need of dietary supplementation as determined by a licensed medical practitioner. Methazel should be administered under the supervision o f a licensed medical practitioner.

Antiepileptic drug s (AED): The AED class including , but not limited to , phenytoin, carbamazepine, primidone, valproic acid, fosphenytoin, valproate, phenobarbital and lamotrigine have been shown to impair fo late absorption and increase the metabolism of circulating fo late.

Additionally, concurrent use of folic acid has been associated with enhanced phenytoin metabolism, lowering the level of the AED in the blood and allowing breakthrough seizures to occur. Caution should be used when prescribing this pro duct among patients who are receiving treatment with phenytoin and other anticonvulsants.

Concurrent administration of chloramphenicol and folinic acid in folate-deficient patients may result in antagonism of the haemato poietic response to folate.

Caution should be exercised with the concomitant use of folinic acid and trimethoprim- sulfamethoxazole for the acute treatment of Pneumocystis cariniipneumonia in patients with HIV infection as it is associated with increased rates of treatment failure and mortality in a placebo controlled study.

Vitamin B6 should not be given to patients receiving the drug levodopa because the action of levodopa is antagonized by vitamin B6. However, vitamin B6 may be used concurrently in patients receiving a preparation containing both carbidopa and levodopa.

Folic acid when administered as a single agent in doses above 0.1 mg daily may obscure pernicious anemia, in that hematologic remission can occur while neurological manifestations remain progressive. The 2 mgs of B12 (cyanocobalamin), the amount contained in Methazel, has been shown to provide an adequate amount of B12 to address this precaution. Unmetabolized folic acid has been shown in one study of 105 postmenopausal women (50-75 yrs) to have the potential to reduce natural killer cells’ cytotoxicity, which may result in an impaired immune response.

B12 should not be used in those with Leber’s optic atrophy. Decreased levels of B have been associated with reduced ability to detoxify the cyanide in exposed individuals and B may increase the risk of irreversible neurological damage from optic atrophy in those affected with the disorder. Hydroxocobalamin can aid in the detoxification of cyanide. This form of B12, although not in this product, is an acceptable form for >B12 supplementation in those with this disorder.

Caution should be exercised when Methazel is administered to patients with diabetic nephropathy. One published study showed that among patients with diabetic nephropathy given high dose folic acid, vitamin B12, and vitamin B (pyridoxine) versus a placebo, there was a greater decrease in glomerular filtration rate (GRF).

Pregnant women and nursing mothers may be recommended to use 12 microgram doses of B12 from nutritional supplements, although higher doses should only be taken on the recommendations of a prescribing medical professional. Administration of doses of vitamin B12 greater than 10 micrograms daily may produce a hematological response in those with anemia secondary to folate deficiency.

Folate, when administered as a sing le agent in doses about 0.1 mg daily, may obscure the detection of vitamin B12 deficiency (specifically, the administration of folic acid may reverse the hematological manifestations of B12 deficiency, including pernicious anemia, while not addressing the neurological manifestations).

Methazel is not intended for use as a prenatal/postnatal multivitamin for lactating and no n- lactating mother. T his pro duct contains B vitamins in active form. Talk with your medical practitioner before using if pregnant or lactating.

Allergic sensitization has been reported following both oral and parental administration of folic acid, and may possibly occur with other forms of folate. Paresthesia, somnlence, nausea and headaches have been reported with vitamin B6. Mild transient diarrhea, polycythemiavera, itching, transitory exanthema and the feeling of swelling of the entire body have been associated with vitamin B12.

Store at controlled room temperature 15°-30°C (59°F-86°F). Keep in cool dry place. Call your doctor about side effects. You may report side effects to FDA at 1-800-FDA-1088. KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN.

Reserved for Professional RecommendationAll prescriptions using this product shall be pursuant to state statutes as applicable. This is not an Orange Book product. This product may be administered only under a physician’s supervision. There are no implied or explicit claims on therapeutic equivalence.

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METHAZEL- methazel capsule

Number of versions: 1

RxNorm

METHAZEL- methazel capsule

Out of scope - Out of scope for RxNorm and will not receive RxNorm normal forms. Out of scope information includes radiopharmaceuticals, contrast media, herbals, homeopathics, and food. Drug names that are ambiguous or not compatible with the RxNorm system, such as multivitamins with more than 4,000 characters in their names, are also out of scope.

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